Medical network - January 11 countries officially put into use after long-distance medical billing system, ginseng protect personnel to pay only by the individual to assume the cost of medical treatment of be in hospital, other expenses by orgnaization of agency of medical treatment to the medical establishment that decide a dot to pay after checking according to the agreement.
For the period of ms, when a country long-distance medical billing platform will be officially running, is crucial.
Mother for lung cancer treatment in Beijing for two years, more than 50 can in their hometown in Shanxi Province, most of the coverage of medical expenses, but ms side to take care of patients, and to raise the major medical advances, together with Beijing home back and forth to your local health department to submit an expense account, the toil to period of ms.
During long-distance medical insurance reimbursement, there are "mat endowment" and "errands" two big pain points. This problem, as people club department late last month announced a national long-distance medical settlement system online, inter-provincial long-distance medical direct settlement officially into the implementation stage.
Recently released the "much starker choices-and graver consequences-in" deepening the reform of medical health system planning, "said the 2017 basic implementation to meet the requirements of referral long-distance medical hospitalization expense settlement directly.
The launch of the country, however, different ground settlement system are only the first step to towards the different health direct settlement. First financial reporter survey found that some areas of medical insurance fund pressure, now faces a serious balance of payments "excessive medical treatment" and is common in our country. How to make a long-distance medical behavior regulation and medical costs of the audit, will be decided is the key to the sustainable development of different ground settlement system.
A long-distance YangLaoZhe benefit
Since 2016, the government has been accelerating the basic medical insurance nationwide network and long-distance medical hospitalization medical expenses directly across the province the pace of the settlement. Long-distance medical direct settlement policy, the goal is to achieve premier li keqiang proposed "make reasonable different ground settlement is no longer the pain points of the masses", and not everyone can go to a doctor.
People club department and the ministry of finance jointly issued last month regarding the basic medical insurance inter-provincial long-distance medical hospitalization medical expenses directly settlement work notice "(hereinafter referred to as" notice ") regulation, only four kinds of people can apply for inter-provincial long-distance medical hospitalization expense settlement directly, respectively is: relocated retirees, beyond the long-term resident living people, different staff, different referral.
Hospital management research institute, tsinghua university professor Yang was the first financial journalist, said a long-distance direct settlement is conditional, not the people of the whole country in the future can be "roaming the doctor". This policy is the main beneficiary of the relocated retirees and retirees with children's life, make this part of the people in where the doctor don't have to "mat endowment" and "errands".
A mass migration of population in recent years following children leave home pension of retirees, greatly increased. Hometown is Beijing residents in jiangsu ms zhao told the first finance and economics, mother because of cerebral hemorrhage in Beijing a few years ago, fee spent fifty thousand multivariate, long-distance medical treatment need payment first patient himself, the money all by home a few brother and sister are brought up. From a doctor to finally complete, spent months before and after the formalities of trouble.
Countries officially put into use after long-distance medical billing system, ginseng protect personnel to pay only by the individual to assume the cost of medical treatment of be in hospital, other expenses by orgnaization of agency of medical treatment to the medical establishment that decide a dot to pay after checking according to the agreement. Relocated and pensioners living in exotic foreign medical direct settlement this terrible problems will be readily solved.
, people club department established schedule at the end of 2016, realize the basic national health care network, start the relocated retiree hospitalization medical expenses directly across the province settlement work; In 2017 began to gradually solve provinces relocated retiree hospitalization medical expenses directly and settlement, the end of 2017 to expand to conform to the stipulations of the referral personnel of long distance medical hospitalization medical expenses directly and settlement.
Different ground treatment is not encouraging patients
Long-distance medical treatment after clearing system enabled, cross-regional settlement will be more convenient and quick, but it's not that encourage patients to big cities, on the contrary "notice" requirements coverage combined with hierarchical diagnosis and treatment of propulsion, establish reasonable mechanism of referral.
People club department did a baseline survey is a long-distance medical treatment, the results showed 60% of long-distance medical treatment is within the prefecture level across the county, 30% is in the province of intercity for medical treatment, only 10% is the medical need across the province.
Yang was said, need across the province long-distance referral just a fraction of heavy patients. Health department charge should through the medicare payment reform improve the enthusiasm of local 3 armour hospital to solve intractable diseases as unnecessary referral of patients to provide satisfactory medical services.
In cross-regional referral, basic all referrals from economic less developed areas to developed areas, then the problem is the rising cost of health care and long-distance medical expense increases, will cause pressure to more funds for health care.
The first financial journalist at the local health department learned that some areas every year health spending will account for all health care spending and 30, the percent of management better area will account for more than 10%, and this momentum is growing gradually.
Yang was said, increasing referral on the one hand, shows that patients have a higher request to the medical service quality, on the other hand also show some areas of hospital management and medical insurance fund management problems.
If the government does not improve the system of grading referral as soon as possible, let patients choose agencies, long-distance real-time settlement, is bound to cause patients to hospitals in big cities like Beijing and Shanghai. Ginseng to orgnaization of agency of medical institutions and health care how to determine whether reasonable, referral is related to different ground settlement if the policy will be "abuse".
Need to measure the ability to pay
To implement health care beyond the direct settlement as soon as possible, the countries different ground settlement platform and no unified national treatment pay policies, but took a compromise: inter-provincial long-distance medical, execute the relevant provisions of the medical treatment pay limits and in principle, including the basic medical insurance drug catalogue, diagnosis and treatment projects and medical services standards. As a whole of fund of insurance of primary medical treatment to fu biao, pay scale and highest pay limitation, in principle, implementation of ginseng land policy.
Which is the problem with this method, the ginseng to orgnaization of agency of medical treatment will be difficult to control settlement directly after a long-distance medical expenditures. An unnamed industry insiders said, once patients across the province, local medical directory will fail, they can control is fu biao and payment proportion pay policies, and cannot be foreign to medical institutions of medical services for the intelligent audit and monitoring.
Although people club department also notice to strengthen supervision, but from the point of now platform works, facing to inhibit long-distance medical moral risk and the risk of excessive medical treatment lack of effective means. "Due to join the medical insurance agency orgnaization to go to a doctor to the hospital without any binding, hospital and patients easily, thus to spend money according to maximum reimbursement ratio, and the state of the system is unable to monitor, prone to cost deficit." The person said.
In order to guarantee the normal operation of national long-distance medical billing platform, the man decided to build system of imprest gold club department and the ministry of finance. Ginseng to advance to go to a doctor for the payment of medical treatment cost money, long-distance medical personnel in principle according to to pay for two months last year long distance lines for approval of the medical expenses, according to the years of liquidation.
According to regulations, advance in principle from the region as a whole fund of medical treatment insurance. The region as a whole in our country the status of the medical insurance fund inequality and drought can also makes the deposit on time full specified amount collection become an open question, for some of the medical insurance fund is almost the bottom of the "wear", pay in advance two months each year the imprest gold isn't easy.
This, he says, is now a long-distance medical billing policy for ginseng to pressure is very big, it is to hand over money, not for medical service project audit, only through a starting line of a standard to control the cost, etc. Once the deposit finished, to go to a doctor will stop providing medical services, and local governments must also for long-distance medical insurance fund settlement come out.
"As a branch of medical insurance fund surely with closing, ability to pay everything. Long-distance medical settlement system should be comprehensive consideration from all over the ability to pay, not local funds won't be able to afford, is damaged the interests of the beneficiaries." The person said. |
